ON THE FATE OF THE HUMAN EMBRYO IN TUBAL PREGNANCY. 



97 



of the fimbriated end of the right tube, 25 mm. in length, 

 and a portion of the right ovary, which has been sectioned, 

 disclosing a large corpus luteum, 19X19 mm. The tube 

 evidently extends from the fimbriated end to the point of 

 rupture, whence a similar slab of tissue has been removed 

 and whence a blood clot about 12 mm. in diameter pro- 

 trudes. Sections were taken through three portions of 

 the tube. Those through the uterine end show that the 

 tube was quite fibrous. At certain places were several 

 very large pockets, but no indication of acute inflamma- 

 tion. In the middle of the rupture the folds were very 

 pronounced and adherent to the actively proliferating 

 mucous membrane and there were numerous pockets in 

 the wall. Several villi extend through the muscular coat, 

 and these have attached to their tips a very active tro- 

 phoblast. At the fimbriated end are also outpocketings 

 through the mucous membrane into the muscular wall. 



No. 900/. 



(Dr. R. W. Hammack, Manila, Philippine Islands.) 

 Tubal mass, 40X32X25 mm. From a Malay woman, 

 26 years of age, who had had 9 pervious pregnancies without 

 any abortions. The last period during June 1913; operated 

 upon September 21, on account of continued bleeding and 

 pelvic pains during the previous six weeks. Venereal 

 disease was denied. At the time of the operation it was 

 found that the right tube was somewhat enlarged and had 

 ruptured at the outer end of the middle third. The 

 omentum was adherent to the pelvic organs and the left 

 tube was distended with bloody fluid. There was also a 

 backward displacement of the uterus. The specimen 

 consists of the right and left Fallopian tubes. The main 

 portion of the former is occupied by the pregnant mass, 

 which consists of a blood infiltration and a partially exfoli- 

 ated wall of the ruptured tube, some villi being here and 

 there evident. The embryonic remnants are not seen. The 

 entire left Fallopian tube measures about 40X15 mm. 

 On one side this tube is distended into the vesicle, which 

 shows a lumen 20 mm. in diameter. This cavity is lined 

 with folds and at one point it is about to rupture. The 

 abdominal opening of the tube is closed. 



From the right (ruptured) tube sections were cut from 

 the uterine end through the point of rupture. The lumen 

 of the uterine end is lined with delicate folds and within 

 it has a slight exudate. None of the folds is adherent. 

 The section through the middle of the tube (that is, through 

 the point of rupture) has reached the lumen of the tube at 

 .several points and shows in it a clot, separated from the 

 tube wall by numerous cells which look like those of tro- 

 phoblast. At certain points are several large lumps of 

 syncytium; also a considerable amount of nuclear dust, 

 which seems to have arisen from the syncytium. No defi- 

 nite villi were found in the sections, although they appeared 

 to be present when the gross specimen was first examined. 

 The folds are largely free and from their bottoms proceed 

 numerous outpocketings, which grow into the muscular 

 wall. On the left side sections were taken through the 

 uterine end of the tube and through the vesicle near the 

 fimbriated end. The folds of the lumen at the uterine end 

 are very pronounced, often running out into processes, and 

 at the muscular border are several small outpocketings. 

 Outpocketings are also seen on the muscular wall adjacent 

 to the distented portion. 



No. 900?. 



(Dr. R. W. Hammack, Manila, Philippine Islands.) 

 Tubal mass, 33X21X18 mm. A Caucasian, age 22, 

 born in the Orient; married in 1912, one previous preg- 



nancy. There is an indefinite history of an abortion on 

 September IS, 1912. The last normal menstruation period 

 began May 2, 1913, and there was a slight flow on June 

 19. Operation in July 1913. Smear preparations were 

 made from the cervix, but no gonococci could be found 

 At the time of the operation the lube was found ruptured 

 and there were numerous adhesions to the pelvic organs. 

 The left ovary was cystic, measuring 40 mm. in diaineh i 

 The right ovary and tube appeared to Ije normal. The 

 uterus was slightly enlarged. No embryo was found at 

 the time. The specimen consists of the left Fallopian 

 tube and ovary. The tube, which is in a Fragmentary con- 

 dition, has been ruptured and also freely opened. The 

 ovary, which now measures 33X18X21 mm., is occupied 

 chiefly by a large cyst, the wall of which consists entirely 

 of lutein tissue, somewhat over 2 mm. in thickness. Sec- 

 tions were cut through the middle of the rupture and 

 through the uterine end of the tube. The lumen of the 

 uterine end is normal in form and has several outpoeket- 

 ings. There are also signs of inflammation. The .section 

 from the rupture shows that the folds of the tube are largely 

 necrotic and infiltrated with round cells. The tips of the 

 folds are disintegrating. Within the lumen is a small 

 mass of fibrinous exudate. There are also several outpock- 

 etings in the muscular wall. No trace of an ovum was 

 found. 



No. 900/. 



(Dr. R. W. Hammack, Manila, Philippine Islands.) 

 Tubal mass, 60X50X40 mm. From a Malay woman, 

 aged 25, who had given birth to 3 children but had had no 

 abortions. The last menstrual period took place October 

 25, and after its termination began again on the 29th, con- 

 tinuing until the operation, which took place December 

 14, 1913. At the time of the operation it was found that 

 the right tube presented two swellings, each containing a 

 clot of blood. The cavity was found practically filled with 

 fluid and clotted blood. The specimen consists of the 

 right Fallopian tube and ovary, the tube being in a frag- 

 mentary condition owing to an extensive dissection, but. 

 clots are here and there present and also what is apparently 

 chorionic tissue. A section was cut through one of the 

 larger blocks of tissue; it includes the uterine end of the 

 tube as well as the blood clot within the opening of the 

 rupture. The lumen of the uterine end of the tube is 

 packed with a mass of tissue formed by many adhesions 

 of the folds of the tube; numerous outpocketings reach far 

 into the muscular layer. This is evidently a case of fol- 

 licular salpingitis with many outpocketings. At the point 

 of rupture the form of the folds of the tube appear to be 

 quite normal and no pronounced pockets can be seen, but 

 at some points there is inflammation. The clot appears 

 to be old and quite irregular in form; and it contains a few 

 villi of the chorion in the last stage of degeneration. At 

 one point there is a considerable mass of trophohlast cells. 



No. 904. 



(Dr. George Stickney, Baltimore, Maryland.,) 

 Unruptured tube, 70X55X40 mm. Embryonic rem- 

 nant 1 mm. long. The specimen was sent to the labora- 

 tory perfectly fresh and placed immediately in Bouin's 

 solution, after which it was transferred to alcohol. Later 

 it was cut into blocks and sections were taken through the 

 uterine end of the tube and through the middle of the 

 enlargement, which struck the cavity of the chorion. The 

 diameter of the chorionic cavity is about 10 mm. The 

 tube is filled with a mottled mass, portions of which are 

 opaque. These are composed of organized blood, but there 



